Disentangling the complex racial disparities in health among adult beneficiaries under Medicaid managed care: A structural equation modeling approach.

摘要

There are few studies of the important issue of racial and ethnic disparities in Medicaid managed care settings. This study addresses this deficiency using data collected by telephone interviews from a randomly stratified sample of adults who were continuously enrolled in North Carolina Medicaid managed care for at least six months prior to sampling in 2006. It uses univariate statistics to describe health status and conducts a Pearson chi-square test to examine health status between non-Hispanic black adults and non-Hispanic white adults. Because chronic conditions were significantly related to health status, the study also computes three separate structural equation models to investigate the complex relationships between race, health status, and a number of other independent variables that theory suggests.;The Medicaid managed care adult population had bad health: 50.02% reported "poor" or "fair" health, and 63.60% suffered from a chronic condition. Yet, contrary to most of the literature on race and health, the health status of non-Hispanic black adults in this study was significantly superior to that reported by non-Hispanic white adults. This surprising finding held for both the model of overall sample of adults, which fitted adequately with the sample data (CFI=0.921; RMSEA=.035) and explained 31% of the variance in health, and the model of adults with chronic conditions, which also fitted adequately with the sample data (CFI=0.93; RMSEA=.036) and explained 22% of the variance in health.